Outcomes of Botulinum Toxin Injection for Shoulder Internal Rotation Contractures in Infants with Brachial Plexus Birth Injury

Singh, Amrik; Manske, M. Claire; James, Michelle A.

doi:10.1016/j.jhsa.2020.06.008

Cited by 7 publications

(12 citation statements)

References 29 publications

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“…Both Greenhill et al. (2018) and Singh et al. (2020) found that only about 15% gained good active external rotation in adduction without the need of further procedures.…”

Section: Discussionmentioning

confidence: 99%

“…No consensus exists about the right dosage, targets, timing and efficacy of BTX injections (Buchanan et al., 2019; Ezaki et al., 2010; Michaud et al., 2014; Singh et al., 2020). Reported dosage varies between 7.4 and 10 IU/kg, and the target muscles include the supraspinatus or pectoralis muscles, or equally divided between all four internal shoulder rotator muscles (Ezaki et al., 2010; Greenhill et al., 2018; Michaud et al., 2014; Singh et al., 2020) followed by shoulder spica bracing for 4 to 6 weeks. BTX treatment, in itself, is seldom sufficient to maintain shoulder congruence; therefore, children that do not regain active Mallet Grade III or higher global external rotation should be considered for either tendon or nerve transfer (Nikolaou et al., 2011; Waters et al., 2009).…”

Section: Discussionmentioning

confidence: 99%

“…Another important part of our protocol is the use of early BTX treatment to reduce further dysplastic changes by retaining congruency and enabling passive shoulder ER exercises while awaiting possible recovery of active shoulder external rotation. No consensus exists about the right dosage, targets, timing and efficacy of BTX injections (Buchanan et al., 2019; Ezaki et al., 2010; Michaud et al., 2014; Singh et al., 2020). Reported dosage varies between 7.4 and 10 IU/kg, and the target muscles include the supraspinatus or pectoralis muscles, or equally divided between all four internal shoulder rotator muscles (Ezaki et al., 2010; Greenhill et al., 2018; Michaud et al., 2014; Singh et al., 2020) followed by shoulder spica bracing for 4 to 6 weeks.…”

Section: Discussionmentioning

confidence: 99%

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A protocol-based treatment plan to improve shoulder function in children with brachial plexus birth injury: a comparative study

Grahn

Sommarhem

Nietosvaara

2021

J Hand Surg Eur Vol

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Children with permanent brachial plexus birth injury have a high risk of developing posterior shoulder subluxation. In 2010, we implemented a protocol to reduce the incidence of this deformity, including early passive exercises, ultrasound screening, botulinum toxin-A injections, shoulder splinting and targeted surgeries. Two-hundred and thirty-seven consecutive children treated at our institution, with a mean follow-up of 11 years (range 1 to 17) were compared in three groups: children born from 1995 to 1999 ( n = 53), 2000–2009 ( n = 109) and 2010–2019 ( n = 75). Posterior shoulder subluxation developed in 48% of all patients but the mean age at detection of shoulder subluxation decreased from 5 years to 4.9 months. Need for shoulder relocation surgery also decreased from 28% to 7%. Mean active shoulder external rotation in adduction improved from 2° to 46°. In conclusion, our established protocol has the potential to reduce the incidence of posterior shoulder subluxation in children with brachial plexus birth injury. Level of evidence: II

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“…Both Greenhill et al. (2018) and Singh et al. (2020) found that only about 15% gained good active external rotation in adduction without the need of further procedures.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

A protocol-based treatment plan to improve shoulder function in children with brachial plexus birth injury: a comparative study

Grahn

Sommarhem

Nietosvaara

2021

J Hand Surg Eur Vol

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“…The summarized effect size showed a significant increase in passive ROM of shoulder external rotation without significant heterogeneity (SMD, 0.678; 95% CI, 0.423 to 0.934, I 2 = 17.4%; Figure 3). Three articles [33,34,38] reported the AMS for shoulder external rotation. The results revealed a significant improvement in AMS score after BoNT without significant heterogeneity (SMD, 0.47; 95% CI, 0.131 to 0.808, I 2 = 0.000%; Figure 4).…”

Section: Shoulder Jointmentioning

confidence: 99%

“…Healthcare 2022, 10,2419 Three articles [33,34,38] reported the AMS for shoulder external rotation. The revealed a significant improvement in AMS score after BoNT without significant geneity (SMD, 0.47; 95% CI, 0.131 to 0.808, I 2 = 0.000%; Figure 4).…”

Section: Shoulder Jointmentioning

confidence: 99%

The Effectiveness and Safety of Botulinum Neurotoxin in Obstetric Brachial Plexus Injury: A Systematic Review and Meta-Analysis

Chen

Lin

et al. 2022

Healthcare

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Obstetric brachial plexus injury, also known as neonatal brachial plexus injury, is not unusual in newborns. Given the lack of a comprehensive synthesis of the available data on the effectiveness of botulinum neurotoxin (BoNT) in treating children with obstetric brachial plexus injury, we conducted a systematic review and meta-analysis. We searched PubMed, Embase, Web of Science, and Cochrane databases from inception to 25 November 2022. Outcomes were function of the shoulder and elbow joints, muscle power of the deltoid, biceps brachii and triceps brachii, and the recurrence rate of subluxation or dislocation after reduction of the shoulder joint after BoNT application. Meta-regression was conducted to assess the moderator effect of age. We included 11 case series and 2 cohort studies. Passive range of motion of shoulder external rotation (standardized mean difference [SMD], 0.678; 95% confidence interval [95%CI], 0.423 to 0.934), Active Movement Scale for shoulder external rotation (SMD, 0.47; 95%CI, 0.131 to 0.808), and active range of motion of elbow extension (SMD, 2.445; 95%CI, 1.556 to 3.334) increased significantly after BoNT. However, the modified Gilbert scale for shoulder abduction (SMD, 1.239; 95% CI, −0.2 to 2.678), the Toronto score for active elbow flexion (SMD, 1.099; 95% CI, −0.053 to 2.252), muscle power of deltoid (SMD, 0.675; 95% CI, −0.599 to 1.949), biceps brachii (SMD, 0.225; 95% CI, −0.633 to 1.083), and triceps brachii (SMD, 1.354; 95% CI, −1.493 to 4.202) did not reach statistical significance. The moderator effect of age was not significant (p = 0.88). Meta-analysis was not done for recurrence rate of subluxation or dislocation due to insufficient data. In conclusion, our data support BoNT use in patients with obstetric brachial plexus injury. However, definite conclusions cannot be drawn due to small sample size and the lack of randomized controlled trials. More research is warranted to clarify the effectiveness of BoNT in patients with obstetric brachial plexus injury by using standardized injection protocols and outcome measurements.

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Glenohumeral Joint Secondary Procedures for Obstetrical Brachial Plexus Birth Palsy

Cornwall,

King

2023

The Pediatric Upper Extremity

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Outcomes of Botulinum Toxin Injection for Shoulder Internal Rotation Contractures in Infants with Brachial Plexus Birth Injury

Cited by 7 publications

References 29 publications

A protocol-based treatment plan to improve shoulder function in children with brachial plexus birth injury: a comparative study

A protocol-based treatment plan to improve shoulder function in children with brachial plexus birth injury: a comparative study

The Effectiveness and Safety of Botulinum Neurotoxin in Obstetric Brachial Plexus Injury: A Systematic Review and Meta-Analysis

Glenohumeral Joint Secondary Procedures for Obstetrical Brachial Plexus Birth Palsy

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